Download Metastatic Liver Lesions - Procedure Profile

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Metastatic Liver Lesions
Introduction
Liver Disease
Management &
Transplant
Program
At California Pacific Medical
Center we are committed to
bringing new and advanced
diagnostic tools, medical
treatments and surgical options
to the physicians and patients
we serve. Through this procedure profile, our physicians
illustrate current and emergent
treatment options we can
provide for the specialized
medical management of your
patients.
Many recent advances in medicine and
surgery have made it possible to success­
fully treat, and sometimes cure, cancers
that were previously considered incur­
able. At California Pacific Medical Center,
these advances have been incorporated
into a multidisciplinary approach that
can offer treatment for most patients
who have developed metastatic liver
lesions from malignant tumors such
as colon cancer or breast cancer. Our
team of specialists will work with you to
provide a comprehensive treatment plan
that includes the latest technology in
diagnosis and treatment.
What are Metastatic
Liver Lesions?
Cancer can develop in any organ and
each cancer acts differently in its
tendency to spread to other organs.
When a cancer has spread to the liver,
it is referred to as a metastatic liver
lesion. Sometimes the metastatic
lesion is identified at the same time as
the original cancer (synchronous) and
sometimes the metastatic lesion is
discovered later, after the original cancer
has been treated or surgically removed
(metachronous).
Our promise to our patients
is to deliver the highest quality expert care with kindness
and compassion. We go beyond
medicine to treat the whole
person, not just the illness.
Liver
For patient referrals:
1-888-637-2762
www.cpmc.org/liver
Copyright 2009, Medi Visuals, Inc.
Medicine can transform a body.
Going beyond medicine can
transform a life.
Transverse colon
(shown in section)
Most Severe
california pacific medical center
The liver has two separate sources
of blood supply: the hepatic artery
(provides oxygenated blood) and
the portal vein (carries blood from
the intestines back to the liver for
extraction of nutrients). For this
reason, the liver is the most com­
mon site for metastasis from gas­
trointestinal cancers, such as colon
cancer or pancreatic cancer.
Detecting and
Staging Metastases
When cancer has spread to the
liver, it typically does not cause
any symptoms. As a result, most
patients do not notice any change
in their health. Blood tests and
imaging, such as CT scan or
ultrasound, are important tools
to detect metastatic liver lesions
at an early stage, when they are
most effectively treated. These tests
can also be helpful in determining
if the cancer has spread to areas
in addition to the liver. In some
patients additional testing, such
as a positron emission tomogra­
phy (PET) and MRI scan may be
required to determine the extent of
the liver metastases.
The liver’s eight-segment division shows the liver’s two separate sources of blood supply: the
hepatic artery and portal vein.
Treatment Options
for Metastatic Liver
Lesions
Once a metastatic liver lesion is
detected, patients should undergo
a rapid medical, oncologic and surgi­
cal evaluation to determine the most
appropriate treatment. The treatment
Two metastatic lesions appear in the liver’s left hepatic lobe of this
CAT scan.
may vary between patients, and will
be tailored to best fit each indi­
vidual’s specific needs. Frequently,
combinations of treatments, rather
than a single type of treatment will
be required, and you will meet with
a team of specialists to discuss these
different options during your evalu­
ation.
This CT image shows metastatic lesions within the right lobe of the liver.
california pacific medical center
Chemotherapy
Systemic Chemotherapy
The most common treatment used
for metastatic liver lesions is systemic
chemotherapy. In this treatment,
anti-cancer medications may be de­
livered intravenously, or by ingestion
of an oral preparation containing the
anti-cancer drug.
Cancer cells vary widely in their
response to systemic chemotherapy,
and some cancers respond well to
chemotherapy, while others may be
unaffected. This type of treatment is
commonly offered for patients who
have large malignant tumors that
cannot be removed surgically, or
patients who have cancer spread to
other organs in addition to the liver.
Transarterial
Chemoembolization (TACE)
Some patients may be more appro­
priate for a specialized form of che­
motherapy, TACE, which uses special
catheters to deliver chemotherapeutic
drugs directly into the artery supply­
ing the liver. This procedure focuses
the anti-cancer effect on the meta­
static lesions in the liver, and tends
to have fewer side effects commonly
seen with systemic chemotherapy.
TACE has the added advantage of
being able to partially block the
blood supply to the area of the cancer,
depriving the blood supply needed
by the cancer cells for nutrients and
oxygen. For most individuals TACE is
well-tolerated, with few side-effects,
and can frequently be performed as an
outpatient procedure.
Radiofrequency
Ablation
Patients with small metastatic tumors
may be best treated with radiofre­
quency ablation (RFA). With this
procedure, a specially designed probe
is radiographically guided into the liver
tumor, and radiofrequency energy is
used to destroy tumor cells. During the
procedure, tumor cells are heated to
more than 50O C.
Most commonly, this procedure is
done using laparoscopic surgery
(small incisions on the abdomen), or
performed in the radiology suite, using
CT guidance. In some instances, open
surgery may be required to perform
this procedure.
Surgery
Surgical resection involves re­
moving a portion of the liver that
contains the metastatic lesion. This
treatment is reserved for patients
with no underlying liver disease
(such as cirrhosis), and who are oth­
erwise healthy enough to withstand
a major operation.
Surgeons can remove as much as
70 percent of the liver in attempting
to remove cancerous lesions, since
the liver possesses the ability to
regenerate after surgical resection.
The liver will typically replace the
removed liver volume within several
weeks after surgical resection.
In patients with metastatic liver
lesions localized to one anatomic
region of the liver, surgical resection
offers the best chance for cure. Only
a physician or surgeon experienced
with the treatment of metastatic
liver lesions can determine if surgi­
cal resection is right for you.
RFA may be used for patients who
have unresectable metastatic liver
lesions, or are too ill to undergo
surgical resection, and may be used in
combination with other forms
of treatment.
Microspheres injected during transarterial therapy “lock in” chemo­
therapy and block the blood supply to the tumor.
During radiofrequency ablation, the surgeon deploys electrodes
from a probe that deliver radiofrequency energy. This high heat
causes death of tumor cells.
california pacific medical center
Why Choose Us
Hepatobiliary and pancreas diseases—disorders of the liver, bile ducts,
gallbladder and pancreas—form a
complex set of medical problems
whose treatment often requires
equally challenging minimally inva­
sive or surgical procedures.
At California Pacific Medical Center,
we have been leaders in hepatobil­
iary and pancreas disorders since
the founding of our Liver Disease
and Transplant Program in 1988.
Our doctors are closely involved
in clinical research and surgical innovation. Annually, our physicians
provide care to some 4,000 hepato­
biliary and pancreas patients, both
in San Francisco and at our network
of outreach sites in California and
Nevada.
For patients requiring hospitaliza­
tion, we have a dedicated critical
care liver unit, hospitalists who spe­
cializes hepatobiliary and pancreatic
disease, physician assistants, on-call
anesthesia staff and a specialized
O.R. nursing team. At California
Pacific, our focus is on providing
experienced, personalized care for
all patients.
Sutter Pacific Medical
Foundation
Our hepatologists and hepatobiliary
surgeons are members of Sutter
Pacific Medical Foundation, a non­
profit organization that provides
patient care through its affiliation
with three medical groups. Sutter
Pacific’s 230+ doctors deliver health
care services in San Francisco,
Marin, Sonoma and Lake Counties,
with additional outreach locations
throughout Northern California.
The relationship between Sutter
Pacific physicians and local Sut­
ter Health facilities helps link both
doctors and patients with hospital
services, enabling the highest
quality care delivery. For more
information visit sutterpacific.org.
Cancer Navigation Service
Our Cancer Care Navigation
Service provides individuals and
families assistance with appointment scheduling, patient educa­
tion and support service referral.
Call 1-866-975-COPE (2673) or
email patientnavigation@sutter­
health.org
Genetic Risk Assessment
The Cancer Genetic Risk Assessment Program at California Pacific
offers individuals with a personal
or family history of cancer the op­
portunity to learn more about the
genetic nature of their disease and
whether they may be predisposed
to other cancers which they could
monitor. Individuals meet with our
genetic counselor during which an
evaluation of one’s medical and
family history is performed, as well
as a detailed risk assessment and
genetic education. If appropriate,
genetic testing may be offered and
facilitated by the genetic counselor.
A genetic risk assessment may assist
in medical management decisions
such as aggressive cancer screening
and preventive measures. For more
information, call the Cancer Genetic
Risk Assessment Program at 415­
600-5961 or visit www.cpmc.org/
services/cancer-genetesting/
For more information
Liver Disease Management
& Transplant Program
California Pacific Medical Center,
Pacific Campus
2333 Buchanan Street
San Francisco, Calif. 94115
www.cpmc.org/liver
Hepatologists
Tel. 415-600-1000 (ask for on-call
hepatologist)
Fax. 415-600-1020
Hepatobiliary Surgeons
Tel. 415-600–1010
Fax. 415-600–1012
Oncologists
Tel. 415-923-3012
Fax. 415-928-4840
For referrals and patient
transfer, contact California
Pacific’s Specialty Referral
Program
1-888-637–2762 tel
1-415-600–2955 fax
Printed on 100% recycled paper. Copyright © 2009 California Pacific Medical Center. All rights reserved. TRANLIV- MetasticLiv-prof-2009